HomeMy WebLinkAboutBLD1989-00521 _ ,
IS
BUI -' NG PERMIT APPLICATION
_.-
Jefferson County Building , partmenttq' .0 . Box 12200Po _ Townsend, WA 98368. .
LocATIoll Oil cl._'tee(-)LJL--,S±crtke._
SPECIFIC LOCATION SITE ADDRESS Z411IR*LqRr7P.-,0
! SION ff/tE:Po PooriT Tit<c-1-
POSTAL DISTRICT _ UB
LEGAL DESCRIPTION LOT ICI BLOCK DIVISION TAX NUMBER
PARCEL NUMBER (!?4-9J , A1.-1 Caa_ 1 / 4 SECTION
SECTIONS TOWNSHIP 30 NORTH RANGE 1 .....- WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
jgESINGLE FAMILY ARNEW BUILDING MAIN FLOOR a,a_oo
O MOBILE HOME D ADDITION 2ND FL&V 3go
O MODULAR HOME U ALTERATION BASEMENT
O DETACHED/ATTACHED
Li REPAIR CARPORT
GARAGE D REPLACEMENT GARAGE
O WOODSTOVE D WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS____ MOBILE HOMES
0 COMMERCIAL SIZE _JEDO
0 INDUSTRIAL
39
MAKEAI .0 vA
@ $ 16 5/ C-)2- -
0 HOTEL/MOTEL/DORMITORY
NUMBER OF UNITS (00-1/ 0 @ $8 4/7 -'- -- —
O OTHER - SPECIFY
------0 @ ESTIMATED COST OF $8
IMPROVEMENTS
;
) 3 $2;. OTAW1/1721.LCET VALUE
UBC OCCUPANCY GROUP
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
, WOOD FRAME ( ELECTRICITY n COLLECTIVE SOLAR
O MANUFACTURED D WOODSTOVE D PASSIVE SOLAR
0 STRUCTURAL STEEL D GAS D COAL
0 REINFORCED CONCRETE D OIL D OTHER - SPECIFY
O MASONRY ( WALL BEARING )
of DIMENSIONS / 4.4-fl-
O OTHER - NUMBER OF STORIES TOTAL LAND AREA3I; CI
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
6/c71-3/81 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED uNnAryx-wi
APPROVED DATE
E-AINDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
R PUB TYPE OF WATER SUPPLY
D PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY)
PLANNING DE T WITHIN SHORELINE JURISDICTION
0\4,./...e. 5 , ,_2;SLN *YES NAME OF ADJACENT WATER BODY
41/1kils'et- i--ittA6 0
c:Q D NO
I 3-0 ‘APPROVED DATE BANK HEIGHT IC) SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED n YES 0 NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
OWNER
pit-, b' tdjo° — (LI L) At C- . 7-
-
-S10-rd- kVID 6 e 71 ei/t,( - tA--)ce,S Gi 7ff6o7
CONT CR (t_p_aiRREU '7P. 0 - 48)0X a
- STATE LrcrIvbt tio 1
eeT\A_Z r Tyk_. c_6--Ayee, A4 J-F7/64 1.4..,. z 6 Fest,s-
,
ARCH Ret1/1
R--- , -------,
THE 0 HER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS:
SOW URE OF L C T APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
V./C1/47 3g--7&S
jPPROVE V PERMIT FEES
Cig 37 5-3 BASE FEE INSPECTION
A p
e /S7-0,-1-) BLDG SURCHARGE PLAN CHECK
1144h,
AY
- 1Qq 3—S-7-) ENERGY SURCHARGE $ C,, / / .__t
TOTAL
4firRi4i0N, /6 CIEL.R.
PLANNING A joi,s'OUIVrk 911 NUMBER REFUND DATE DATE) ISSUED
BUILDING 6WP40107CL
10.'''kei' 1)• 6/A.- -
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